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Exercise Prescription & Programming

Cancer Rehab Intake Forms
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As I Am a fitness instructor/ personal trainer recovering from can'tcer again as I pursue my EP education, I am preparing to submit a proposal to my treatment center's Wholistic & Integrative Health Services unit for an exercise program for can'tcer patients. Can any of you please send me information, protocols, guidelines, forms, etc. that may help me advance our goals for the good of patients, practitioners, and programs? Feel free to email or call me: IAMJuanita@ymail.com. 678.683.4541. Thank you.

Thank you so much for sending this. It has been a great help!

Guess I should have provided my email for you to respond to--= cxlamber@sentara.com

Cathy Reece

Juliane- am happy to share our cancer rehab intake forms but can you provide your email please so I can attach it from work? thanks

The Henry Ford Program has been a HUGE BENEFIT 4 me. Especially b4 I became a Fitness Instructor/Personal Trainer, now advancing my skillset focused on exercise as medicine for can'tcer patients ... Starting with me! Thank you Dennis!

Hi Juliane,


I just sent you the intake form we use for our exercise oncology program at Henry Ford Hospital in Detroit. I hope it is helpful.



Hi All,


I am currently in process of revamping a Cancer Rehab class at my hospital and I am wanting to get some ideas of what to ask on an intake form. I currently working with the general intake form from the ACSM's Guide to Exercise and Cancer Survivorship program.

Is there anything you guys think would be helpful or even send me a copy of your intake forms, so I can get some ideas.


Thanks so much!

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